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a dr taking blood pressure imageApril 26 2018

A study has found ambulatory blood pressure readings taken over 24 hours are a significantly stronger mortality predictor than measurements taken in a clinical setting. 


The findings, described as a “clear game-changer”, have prompted the recommendation that doctors should use ambulatory BP readings before making clinical decisions.

Data was used from over 63,000 Spanish adults between 2004-2014, with a follow up average of 4.7 years. During that period, 3,808 patients died from any cause, and 1,295 of these patients died from cardiovascular causes. Analysis found that 24-hour systolic pressure was more strongly associated with all-cause mortality and cardiovascular mortality than the clinic systolic pressure readings.

The study, published in the New England Journal of Medicine, involved Spanish and UK researchers. 

Research co-lead Professor Bryan Williams, director of the NIHR University College London Hospitals Biomedical Research Centre, said: “For decades doctors have known that blood pressure measured ‘in-clinic’ could be masked or elevated, simply because the patient was in a medical setting, and this could lead to the wrong or a missed diagnosis.

“This research is a clear game-changer, as for the first time, it definitively shows that blood pressure measured regularly during a 24-hour period predicts the risk of heart disease, stroke and death much better than blood pressure measured in a doctor’s surgery or clinic.

“Quite simply, measuring blood pressure over 24 hours is what doctors and medics should be using to make clinical decisions about treatment.”

Professor Graham MacGregor, Chairman of Blood Pressure UK, said: “The findings from the study are very interesting – especially since blood pressure can be variable on its own and specific factors can change day-to-day readings. 

“People can also take action themselves to lower their blood pressure by eating less salt, more fruit and vegetables, taking more exercise and being a healthy weight. Even a small, 10 mmHg, reduction in systolic blood pressure significantly reduces the risk of major cardiovascular disease events; by 20% for coronary heart disease, 27% for stroke, and 28% for heart failure.”

Links:
JR Bangas et al. ‘Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality’. N Engl J Med 2018; 378:1509-1520             
UCL announcement      
NIHR announcement    
Blood Pressure UK comment     

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